EyeCare Professional - September 2009 Issue

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THE COOLEST IN FALL EYEWEAR / PAGE 6 RUNNING AN EFFICIENT LAB / PAGE 18 September 2009 • Volume 3, Issue 21 • www.ECPmag.com

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The alternative photochromic

Corning and SunSensors are registered trademark of Corning Inc., Corning, NY - Copyright Š 2008 Corning Incorporated. All rights reserved.

Photochromic diversity ... up to your wildest ophthalmic dreams !

High quality photochromic monomer - Mid-Index (1.56).

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High performance photochromic monomer - Mid-Idex (1.56).

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UV cut-off improved.

High performance photochromic coating for high indices and polycarbonate - Coating technology - 100 % UVA/UVB blockage.

Ideally suited to high-end lens designs.

www.corning.com/ophthalmic

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EYECAREPROFESSIONAL

SEPTEMBER 2009 Vol. 3 Issue 21

Features 6

Courtesy of Revolution Eyewear

Contents

Magazine

NEW RELEASES FOR THE FALL Keep your practice fashionable this season with the latest in eyewear and sunwear.

by Amy Endo, ABOM, CPOT

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RECLAIMING CONTACT LENSES Contact Lenses were once a large part of an Optician’s dispensary, and they can be again.

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by Warren McDonald, PhD

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THE ART OF LENS TINTING Tinted lenses offer various colors, design options, and benefits to your patients.

by Judy Canty, ABO/NCLE

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RUNNING AN EFFICIENT LAB Process your Lab orders quickly and efficiently and maintain a successful practice.

by Timothy Coronis, ABOC-NCLE

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12

ALL ABOUT AR Anti-Reflective Coating is the ideal product to help your patients and increase your bottom line.

by Carrie Wilson, BS, LDO, ABOAC, NCLEC

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WWW.YOURPRACTICE.NOW Start an internet presence and ensure your practice doesn’t follow the Yellow Pages into obscurity.

by Lindsey Getz

On The Cover: ARCH CROWN 800-526-8353 www.ArchCrown.com

Departments EDITOR/VIEW .....................................................................................................4 SECOND GLANCE ............................................................................................32 ABO PREP..........................................................................................................38 ADVERTISER INDEX .......................................................................................44 INDUSTRY QUICK ACCESS............................................................................47 LAST LOOK .......................................................................................................50

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EYECAREPROFESSIONAL

Editor / view

Magazine

by Jeff Smith

Publisher/Editor . . . . . . . . . . . . . . . . . . . . . . . Jeff Smith Production/Graphics Manager. . . . . . . . . . . Bruce S. Drob Director, Advertising Sales . . . . . . . . . . . . Lynnette Grande Contributing Writers . . . . . . . . . . . . . . . . . Thomas Breen, Judy Canty, Dee Carew, Harry Chilinguerian, Timothy Coronis, Amy Endo, Bob Fesmire, Elmer Friedman, Lindsey Getz, Jim Magay, Warren McDonald, Anthony Record, Ted Weinrich, Carrie Wilson Internet Coordinator . . . . . . . . . . . . . . . . . . . . Terry Adler Opinions expressed in editorial submissions contributed to EyeCare Professional Magazine, ECP™ are those of the individual writers exclusively and do not necessarily reflect the opinions of EyeCare Professional Magazine, ECP™ its staff, its advertisers, or its readership. EyeCare Professional Magazine, ECP™ assume no responsibility toward independently contributed editorial submissions or any typographical errors, mistakes, misprints, or missing information within advertising copy.

ADVERTISING & SALES (215) 355-6444 • (800) 914-4322 lgrande@ECPmag.com

EDITORIAL OFFICES 111 E. Pennsylvania Blvd.

Feasterville, PA 19053 (215) 355-6444 • Fax (215) 355-7618 www.ECPmag.com editor@ECPmag.com EyeCare Professional Magazine, ECP™ is published monthly by OptiCourier, Ltd. Delivered by Third Class Mail Volume 3 Number 21 TrademarkSM 1994 by OptiCourier, Ltd. All Rights Reserved.

No part of this magazine may be used or reproduced in any form or by any means without prior written permission of the publisher.

OptiCourier, Ltd. makes no warranty of any kind, either expressed, or implied, with regard to the material contained herein.

OptiCourier, Ltd. is not responsible for any errors and omissions, typographical, clerical and otherwise. The possibility of errors does exist with respect to anything printed herein.

It shall not be construed that OptiCourier, Ltd. endorses, promotes, subsidizes, advocates or is an agent or representative for any of the products, services or individuals in this publication.

Purpose: EyeCare Professional Magazine, ECP is a publication dedicated to providing information and resources affecting the financial well-being of the Optical Professional both professionally and personally. It is committed to introducing a wide array of product and service vendors, national and regional, and the myriad cost savings and benefits they offer. ™

For Back Issues and Reprints contact Jeff Smith, Publisher at 800-914-4322 or by Email: jeff@ECPmag.com Copyright © 2009 by OptiCourier Ltd. All Rights Reserved

Let AR Reflect on your Bottom Line here are three general components to every lens: the material it is made of; the style or type of correction; and coating. Virtually every lens has all three, and each is important in delivering clear, comfortable vision to the patient. Most ECPs are comfortable with the first two, and do a pretty good job of recommending appropriate products. However, all too often, the third... coatings... is left hanging.

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Don’t believe me? The numbers speak for themselves. According to a recent Vision Council survey, only 29% of U.S. eyewear featured AR Coating, compared to over 50% for the rest of the world (see Carrie Wilson’s article on pg 22 for more info).

Not too many years ago, the only coatings readily available were UV protection and scratch coat. With polycarbonate, and later many of the high index plastic lenses, these were either unneeded or considered a relatively expensive option.

Unfortunately, that caused the development of an attitude of presenting these options as not really necessary, if at all.

When AR was first introduced, there were several problems associated with it that gave the coating a bad reputation. They were prone to crazing (thin cracks), cratering (pits), and even peeling. They were difficult to clean and delicate, so special attention when cleaning the lenses had to be observed to avoid scratches. Advances in coating chemistry and manufacturing have all but eliminated these problems, and in some cases have exceeded the characteristics of even the best lens materials.

The benefits of the coating are obvious when compared to a non-coated lens. The coated lens appears cleaner and clearer, in most cases dramatically so. Because little of the light is reflected back, the lens appears to disappear, and with the proper frame selection, the appearance of wearing glasses is almost eliminated.

Another benefit, perhaps the most significant to the patient, is not so obvious until they actually wear the lenses. Because more light passes through the lens without being reflected off, overall vision is improved. Colors are more vivid, contrast is improved so reading is less tiring, and low light vision is improved.

One of the keys to presenting these rather complex coatings is to keep the presentation simple, use language the patient can relate to, and take advantage of any demonstration aids you might have available. Of course, if you wear eyeglasses, they most certainly should have AR on them.

Wouldn’t it be nice to be able to offer your patient clarity, cleanability, and scratch protection with warranties that often cover all instances for up to two years? So, how do you sell premium AR? Simple: tell them the benefits!

4 | EYECAREPROFESSIONAL | SEPTEMBER 2009

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Fall New Releases

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FALL IS FINALLY IN THE AIR, and what better time to keep your practice current with the season’s most exciting new releases. Look for an assortment of eyewear companies and offer a variable price range that is appropriate for most of the clientele who grace your practice.

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1. Kliik KL-401 is a rectangular full rim metal frame featuring soft brush strokes on the temples. With the addition of colors such as Brown Pumpkin, Khaki Lemon, Black Turquoise and Purple Demi, this frame clearly brings out the wild and stylish traits of the petite frame wearer. KL-403 is an acetate rectangular frame featuring a laser cut, wood carving motif on the temples that creates a three dimensional effect. This model is available in 4 earth tones; Brown Fuchsia, Taupe Teal, Caramel Purple and Grey White. www.kliik.com 2. Allison USA The Moschino MO57002 is an acetate frame that has a three color combination, the front is Black, the outside of the temples is Red, and the inside of the temples is Leopard print.

This sunglass is also available in a solid Black color and solid light Havana color. Again this is exhibits Moschino’s twist on the retro look. www.allison.it 3. BBH Eyewear The new Humphrey’s Collection features an array of dazzling color-contrasts, including a stainless steel look with richlycontrasting galvanized finishes inside and out. The acetate sides, rich in detail, have a fashionable two-color wave design for every personality, from a sophisticated black-silver to a funky violet-pink. The decorative flame designs boast a starkly contrasting yet harmonious symphony of colors. www.bbheyewear.com

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4. Fusion Eyewear SJP125S is one of the 13 new sun releases from Jean Paul Gaultier, the 1980s-style model made entirely of continuous metal threads. The end pieces join onto the temples by means of a trim stud with Swarovski crystals. The open metal temples are particularly light in design, giving a sense of elegant movement. Available in Gunmetal Grey, Matt Black, Bronze and Palladium, with contrasting lenses. www.fusion-eyewear.com 5. Revolution Eyewear True Religion’s “Jesse” is a unisex, modified aviator shape that features leatherette wrapped temples and top bar. Pictured is the “Jesse” in beige with a brown flash gradient lens. The “Jesse” also comes in Black with a Grey lens, Gold with a Gold flash gradient lens, Gunmetal with a Silver flash gradient lens, and Rose Gold with a Rose flash lens. www.revolutioneyewear.com 6. Tura Lulu Guinness model L497 “Evie” is a feminine modified oval front with Lulu’s identifiable initial metal décor on the temples. “Evie” features Lulu’s classic polka dot pattern on the inside on the temples. For the Glamour girls that desire to be all the more noticeable, model L497 is available with the polka dot pattern on the outside of the temples. Available in eyesize 56 x 16 x 130 and in colors: Black, Teal, Tortoise and Black with polka dot temples. www.tura.com

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7. Viva International Group Featured in the women’s optical collection are GU 1602ST and GU 1603ST, showcasing sleek plastic temples that seamlessly blend into metal endpieces, creating a fluid design. A raised “G” logo adorned with glistening crystals completes the look of this innovative metal detail. GU 1602ST features a soft rectangular front in full plastic, while GU 1603ST features a full metal front in a satin finish, also in a soft rectangular eyeshape. www.vivagroup.com 7

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Marcolin

This ultra sexy style from Roberto Cavalli has a tasteful design and modern feel that is perfect for women of all ages.

The intriguing, open cut lens transitions into a smooth circular end piece, where you can see the Roberto Cavalli monogram encrusted with white rhinestones. The RC 457s is also equipped with signature RC adjustable nose pads, for added comfort and a better fit. www.marcolinusa.com

ProDesign

Introducing the elegant and exclusive ZENSE frame with a special hinge, which means that you rotate the temples to fold it. The front itself is quite classical in shape, the temples are slender and the long end tips are made of rubber in terrific colors. Rubber attaches well to the skin so that the frame is held in place, even in very hot weather. There are 4 models in four colors each, and they are suitable for progressive lenses (7342-45 shown). www.prodesigndenmark.com

Luxottica

LBI

ST. MORITZ Ice 220 is the favored frame for feminine fun and fantasy. It features a full-suspension stainless steel and nylon wire front, and the dĂŠcor is an intricate combination of rhinestones and sparkling motif suggestive of a butterfly.

Available in colors Ebony, Grey and Rose, Ice 220 also features soft nose pads and is provided in size 54 x 18 x 135. www.lbieyewear.com

Enni Marco Enni Marco style IV 01430 is simple, but never boring.

This is weightless metal frame with zyl temples that features striking white contrasted with red color combination temples, and perfected with contemporary metal plate embellishment. www.ennimarco.com

The new Tiffany Sunburst TF 2011B features a dazzling intensity that is achieved with a dramatic sunburst that is cleverly incorporated into the hinge mechanism of rectangular frames. The Tiffany & Co. varnished logo appears on temples, with ‘T&CO.’ logo plaque on the inside. Colors range from Black and Dark Havana to Pearly Pink. www.luxottica.com

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UltraPalm

The Caviar 1706 is a bold modern design exclusively from the Caviar Collection featuring an open end piece with all hand set crystals. The 1706 is simply a stunning frame and is available in colors: Gold and Brown. www.ultrapalm.com

EyeQ Eyewear

Marchon Poised and refined, the S845 from Coach is a double laminate zyl, emblazoned with gleaming Swarovski crystals to form a round Coach logo while revealing a rich layering of color. It is

available in five charming tones of Black, White, Tortoise Plum and Tangerine. www.marchon.com

Gripping Eyewear Paris Hilton makes her debut in the eyewear category with a classic, oversized white/crystal frame detailed with elegant fashion forward quilting on the temples. This sensational sun

The Apollo Collection continues its successful fitting and styling concepts, featuring fuller eyesizes, larger bridges with increased flair, and longer temples. The Apollo 147 is a complimenting oval shape with a dazzling temple treatment. www.eyeqeyewear.com

Live Eyewear sports a Tinkerbell magnetic icon embedded in the temples.

Distinctly feminine flowing with the popular trend of gradient lenses...the blue/pink lenses are a reflection of Paris’s personal palette and keen sense of design. www.grippingeywear.com

Low Vision Cocoons® are designed to be worn over prescription eyewear and are available in four absorptive filters; Boysenberry, Hazelnut, Lemon and Orange. The filters feature a balance between contrast enhancement and glare reduction to maximize visual acuity in a variety of light conditions and daily applications. Each tint filters 100% of damaging UVA and UVB light. Low Vision absorptive filters are available in all sizes of Cocoons and include a limited, lifetime warranty. www.cocoonseyewear.com

Whether your patient is looking for a new pair of trendy, elegant, conservative or durable glasses, show them your sampling of new releases. By providing their dream of both great customer service and a superb quality product, they will create word of mouth referrals. Add to that the capability to fully tailor your glasses based on their correct needs, and you’ve got a recipe for success and loyalty for years to come.

Amy Endo, ABOM, CPOT amy@ecpmag.com

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The 21st Century Optician Warren G. McDonald, PhD Professor of Health Administration Reeves School of Business / Methodist University

CONTACT LENSES:

The Optician’s Role In year’s past, Opticians played a major role in the fitting and dispensing of contact lenses in most places in the US. Clearly some of the nation’s best contact lens practitioners are Opticians.

ROFESSIONAL JOURNALS are filled with Opticians articles, and many of the country’s best lecturers on contact lenses are Opticians. Why then do Opticians in most places around the country not fit contact lenses on a regular basis? This article addresses contact lenses as an opportunity for Opticians, and will attempt to objectively describe how Opticians can reclaim some of the contact lens marketplace relinquished to ODs in the 1970s.

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even tell patients they cannot wear lenses if the first attempt does not go as planned. This leaves a huge void. There are thousands of patients who still are fearful of surgical correction and want to wear contact lenses. They may now be presbyopic, which in the past was a concern, but today there are many different varieties of lens choices to meet their needs, if the savvy practitioner simply takes the time to work with each patient as an individual. It will take chair time to find the appropriate design, but it can be done. Opticians can provide those services.

Many people are not aware of gas permeable designs today. In many schools and colleges of Optometry, we understand from colleagues that they are not gaining experience in the fitting of gas permeable lenses. For that reason, soft lenses are recommended as the best alternative. In reality a more rigid (I know....not a pc term today, but I felt this term would provide emphasis for descriptive purposes) design would actually provide the best vision.

These are but two examples; there are others. The point is that there is a demand, and as our OD colleagues move to a more medical model, Opticians can work to fill the void in contact lenses.

Lens Design Specifically, there are a number of lens designs that provide tremendous opportunities in the opinion of this author. Let’s take a look at several of those.

Demand

Multifocal/Bifocal Designs

Is there still a demand for contact lenses? Many see the market as declining or at best remaining static, so why even be concerned about it? Many practitioners see Lasik as a cash cow, and limit their involvement in contact lenses to easy, simple fits and

There are a plethora of multifocal/bifocal designs on the market today, so a specific lens design will not be mentioned. They include Soft lenses, Gas Permeable lenses, Silicone-hydrogel lenses, all with the ability to correct presbyopia. The baby Continued on page 14

12 | EYECAREPROFESSIONAL | SEPTEMBER 2009

lindberg 2112/92 路 PAT. PEND.

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boomers, many of whom grew up wearing contact lenses, do not want to hear that they must now wear spectacles because of presbyopia – and they do not have to any longer. Opticians can help these people solve their visual problems.

A caution – fitting these, and any specialty design, takes time. If you cannot commit to spending significant time with these patients, then do not undertake the case. Also, do not think one size fits all. You would be wary if a contractor came to build your house with only a hammer and nails, and you must have a number of lens designs and types in your “tool kit.”

CRT/Advanced Ortho-K Corneal Refractive Therapy (CRT) www.paragoncrt.com is an alternative to refractive surgery. It is a lens that is worn during sleep that gently reduces myopic correction and has proven itself over the last several years as safe and effective. In fairness, this author served as a consultant to Paragon Vision Sciences, the developer of CRT, but has not had an involvement with them for several years. Paragon has a certification program that is a requirement to fit and dispense these devices.

Take the course, and see what a great addition CRT can be to your practice.

There are other advanced Ortho-K designs as well. The WAVE system is an example www.wavecontactlenses.com. The computer-assisted lenses utilize existing materials to provide a similar alternative to refractive surgery.

Bausch and Lomb www.bausch.com/en_US/ecp/visioncare/ product/general/ortho_ecp.aspx also has a number of select lens designs that combine to form their Vision Shaping Treatment. You will find their system works equally well, and is time proven.

All of these lenses/devices allow for reduction of myopia, and soon will be utilized for the correction of additional optical anomalies. They can be fit by Opticians with the specific equipment required, and in the correct clinical environment.

Post-Refractive Surgery/Irregular Corneas The post-refractive surgery contact lens is something we need to learn more about. Many lens designs are now readily available from a variety of sources, and provide excellent opportunities to assist those who are not pleased with their refractive surgery outcomes, or with irregular corneas. I know the surgeon on your block is probably the latest and greatest, but according to a variety of sources, there are a percentage of patients we can help with these lens designs.

Examples SynergEyes www.synergeyes.com is a hybrid lens design with a 14 | EYECAREPROFESSIONAL | SEPTEMBER 2009

gas permeable center, and a soft lens skirt. It allows for fitting of many complications including corneal scars, grafts, PMD, Kerataconus and others.

Lens Dynamics www.lensdynamics.com offers the Dyna-Z Intra-Limbal lens for irregular corneas. It is an example of the mini-scleral lens mentioned above, and is one that is well recognized for great comfort and has a proven history.

Education and Training Requirements Here lies the problem. Opticians must undertake more advanced education and training requirements to successfully and safely fit contact lenses on a large scale. Great understanding of the technical aspects of fitting is important, and must include course work on anatomy and physiology. Most of the schools of Opticianry include those courses today, but unfortunately most Opticians do not attend a school, but are trained in woefully inadequate “apprenticeship” programs that in reality provide little training and education to these future “professionals” We must do better!

In a study conducted by this author, only 40% of respondents (n= 200) fit contact lenses actively, but in reality many of those only dispense boxes of disposables to patients, or help do insertion and removal. The true number is left unknown, but is suspected to be small. It can grow, however!

The study population indicated that they felt Opticians should assume a greater role in the fitting of contact lenses. 69.5% strongly supported the idea, while 9% felt Opticians should not fit contact lenses at all. 20.5% were neutral. This indicates that Opticians do want to do more in the area of contact lenses.

Next Steps What do we do? It appears there is no one out there seeking to review and advance the professional activities of Opticians.

What needs to happen is two-fold. First, we must educate and train Opticians to assume a larger role as a contact lens practitioner. It will not happen overnight, but one thing I can tell you, it will never happen if we do not take the initiative.

Second, we must develop leaders in professional organizations who respect education themselves and will seek to expand the role of Opticians beyond the boundaries that currently exist.

Conclusion It is imperative that we, as a community of professionals, step up to the plate. We must strive to do more, and reach for greater heights. Contact Lenses are a part of our past, and we must make them a larger part of our future. I encourage you to investigate how you can play a role in contact lens advancement. ■

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21st Century Optics 47-00 33rd St., Long Island City, NY 11101 (800) 221-4170 53 Brown Ave., Springfield, NJ (800) 672-1096 www.21stcenturyoptics.com / www.quickcareframerepair.com Xtreme AR™ is a registered trademark of 21st Century Optics. Crizal, Crizal Alizé, Crizal Avancé are registered trademarks of Essilor International.

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Dispensing Optician Judy Canty, ABO/NCLE

Let’s Talk

Tints ONCE UPON A TIME, tints were easy. The lens material was glass and the choices were pretty basic... ✓ Clear ✓ Pink

✓ Yellow ✓ Green ✓ Grey

Clear for everyday use and of course for night driving. Pink if you worked in an office with fluorescent lighting or for postcataract eyeglasses. Yellow for the sportsman. Green or grey for your sunglasses, if you wore them. Life was simple.

And then the Pittsburgh Plate Glass Co. gave us CR-39 (Columbia Resin 39).

I like to think that Sunshine Somebodyorother was tie-dying some t-shirts when her brand-new, lightweight plastic lenses fell out of their frame into the dye and voila! Custom tinted lenses were born! We could literally look at the world through rose-colored glasses, or purple-tinted lenses in a round metal frame, a la John and Yoko. Our Mothers were coming home from the Opticians with “blue on the top and pink on the bottom” cool new lenses. Life just got a little less simple, at least optical life got a little less simple.

The tint you can’t see for the light you can’t see Ultraviolet light is not a good thing for eyes and skin. It makes things deteriorate, or degenerate as in age-related maculopathy (ARM) or macular degeneration. It can make things grow, like cataracts, pterygium or pinguecula. All eyes should be protected from UV damage, even patients with UV-absorbing lens implants. That’s right! Grandma needs sunglasses too!

Certain medications can make us more susceptible to UV damage, including sulfanomides, tetracyclines, diuretics, tranquilizers and oral contraceptives. Although the questions are sensitive, we need to know about these things when we’re designing the perfect lenses for our patients.

16 | EYECAREPROFESSIONAL |SEPTEMBER 2009

If you can’t see the tint, how do you know it’s there? Simply cover a plastic photochromic lens with the lens in question and expose it to sunlight. If the photochromic lens darkens, there’s not enough UV protection on or in the lens. Use the same test to prove to your patients that cheaply made sunglasses may look good, but can be bad news for their eyes.

UV Index

Exposure Level

(US Weather Service, Environmental Protection Agency, World Health Organization)

012 345 67 8 9 10 11 and greater

Low Moderate High Very High Extreme

Choose the right tint for the right use Pink was once the color of choice for post-cataract glasses and for office workers sensitive to fluorescent lighting. It does not affect the colors seen through it. Currently, pink (rose, flesh) tones are popular for cosmetic tints while the preferred treatment for glare control is the application of an anti-reflective coating.

Yellow is arguably the most controversial of tints. Many longdistance drivers swear by their yellow tinted lenses for comfort and increased visibility at night. However there are no definitive studies that draw that conclusion. Most studies report that there is no increase in visual acuity through yellow lenses, in fact visual performance is slightly worse than through no filter at all. In certain circumstances, a yellow lens can darken a bright Photo: Courtesy of Transitions Optical, Inc.

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blue sky therefore increasing the contrast and making some things easier to see, like perhaps your golf ball in the deep rough. A tinted lens of any color, yellow or otherwise is never recommended for night driving. The reduction in visual acuity (20/20 to 20/32) in dim light is significant enough without further reducing acuity (20/46 behind a tinted windshield at night) by adding even a slight tint (20/46 to 20/60 at night behind a tinted windshield with an 18% tint).

Green lenses transmit light on a curve that is very nearly the same as the color sensitivity of the eye. For many years it was the color of choice for sunglasses, beginning with sunglasses made for the military. Green tinted glass lenses demonstrate good absorption for both UV and IR rays.

Gray, or Grey if you’re British, is the most popular color tint for sunglasses. It does not distort the colors seen through it and is considered a neutral color. It is also the preferred color for people with red-green color deficiencies, since the ANSI requirements for sunglass and cosmetic tints are related to traffic-signal recognition. Interestingly, brown and yellow lenses do not meet the ANSI standards for non-prescription sunglass lenses, but are readily available in prescription lenses. A normal person will not be troubled by those colors, but a color defective person (red-green color deficiency) would not be able to correctly identify traffic signals. That’s another piece of valuable information, like medications, that you should get from your patients.

Brown is a very popular sunglass tint in Europe. Brown tints share some of the same qualities as yellow tints, in that it reduces the transmission of blue light and enhances contrast on bright or hazy days.

Interestingly, the majority of “sport-specific” lens tints fall into the yellow-orange-brown family of colors, some polarized, some not. These particular families of colors filter blue light to enhance acuity and contrast. All are either polycarbonate or other mid- to high-index materials for safety.

Is it me, or do all those sport-specific tints have odd names?

Some days, I miss Gray 88 or G-15.

Primary Function and Shade

To polarize or not to polarize, that is the question For the vast majority of wearers, polarized lenses are the best sun/glare protection available. They reduce fatigue while driving, reduce glare from water and snow or ice and they block UV. However, there are situations where polarized lenses can create hazardous situations. ✓ Some wearers may be sensitive to the stress patterns on car windshields. Polarized lenses may enhance those patterns, which are similar to the “cross” patterns seen on tempered glass lenses when viewed through a polariscope. ✓ Skiers who turn and lean may find that their ability to judge the constantly changing surface of the snow.

Think black diamond, trees and ice patches at speeds topping 100mph. ✓ Golfers may find it difficult to judge the condition of a course. That’s probably why pro golfers seem to be wearing their sunglasses on the backs of their hats. ✓ Pilots may encounter several different problems with polarized lenses: • Polycarbonate windshields may display distracting stress patterns • Some cockpits may have polarized displays which may disappear with polarized lenses.

• Horizontally reflected light from oncoming aircraft is eliminated and the aircraft may not be seen as soon as it should be.

So polarized lenses are the best sunglasses for glare reduction and comfort, except when they’re not.

Finally, tints can be fun and they can be necessary. The key to helping our patients decide which lens, lens tint and/or lens treatment is to ask the right questions including medications, hobbies, occupation and driving habits. Our function as eyecare professionals is to know which combination of material, style, tint and treatment will satisfy those requirements. ■

Light Transmittance

A cosmetic lens or shield (light) More fashion than function

Transmission of greater than 40%

A general purpose lens or shield Normal sunglasses

Transmission of between 8% and 40%

A special purpose lens or shield (very dark) Very intense light

Transmission between 3% and 8%

A special purpose lens or shield (strongly colored) Filters specific spectral colors

3% minimum transmission

—from ANSI Z80.3-2001 SEPTEMBER 2009 | EYECAREPROFESSIONAL | 17

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Lab Corner Timothy Coronis, ABOC-NCLE

How to Run an Efficient Lab

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UTSIDE, IT WAS A SUNNY DAY. White clouds were slowly inching across the blue sky. Inside, the office was running like a well-oiled machine. There were routine exams, complicated exams, and walk-ins.

Each patient was being handled. Complex eyeglass orders were placed aside, to be ordered when things settled down to a simmer. For now, rush jobs were the priority. Red trays entered and left the in-house lab smoothly and easily. The staff was not so much hurrying as buzzing. It looked kind of effortless.

From the front, a patient began to raise his voice. “If I’d known this, I wouldn’t have waited,” said the patient, and soon he was talking with the office manager. Following some activity at the back, a red tray briefly left the lab, was scrutinized, and went back in. Apparently it had been forgotten, or promised, depending on whom you asked.

Lens technology is moving forward at a quick pace, and lenses are becoming increasingly complex. For the most part, top tier lenses are no longer fabricated in-house. More often, we are edging them in-house. There’s still one area in which we can still provide eyeglasses quickly.

There are several things you can do as a team to contribute toward the success of your on-site finishing lab to consistently deliver the rush job ahead of schedule.

Do promise jobs clearly This is what went wrong at the top of the story. The smooth flow of the day was interrupted in a screech. It wasn’t laziness, carelessness, or forgetfulness, but inconsistency. For example, if your lab staff agrees to edge the job “by three o’clock,” don’t tell the patient, “any time this afternoon.”

Do ask It’s always more effective to ask your lab staff what they can do.

Asking gives you an opportunity to say what you need, and gives the lab an opportunity to tell you what they can do. Take a page from reception policy: when doctors take emergency walk-ins, it puts everyone behind, so reception lets the next patients know there will be a longer than usual wait. Ask the lab if they are on schedule. Sometimes, you’ll receive finished jobs sooner than expected, and other times there may be many incoming jobs or an emergency job. Always find out what to expect for turn around times.

Do under-promise and over-deliver The law of the lab is to under-promise and over-deliver. The first prerequisite for working in the lab is comfort in a place of shifting priorities. Jobs flow in a random pattern. In constant change, “under- promise and over- deliver” is the only constant.

It has avoided and resolved countless problems.

Do let the lab own the tray Once you deliver a tray to the lab, let them own it. I once observed a dispenser taking a frame out of the tracer to copy frame numbers and colors. Although those lenses weren’t being edged at that moment, the frame was “on deck,” and moving it fouled up the lab’s system. Don’t bring it to the lab until you’re ready to let them own it.

Photo: Courtesy of FEA Industries, Inc.

Follow the protocol There’s an after hours rush job. It might seem like a time saver to scribble axes on the lens envelopes, and throw them in the tray. But ask yourself how much time this really saves. Now consider how many mistakes could result from going about things half cocked. Doctors don’t write their charts on scraps, and appointments aren’t scheduled on scrap paper. Your office already has a protocol for doing things, and it was established to promote efficiency. Follow it 100% of the time.

Continued on page 20

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Do be complete Everything is signed, dated, and all fields are completed? Being complete is not only professional; it makes your edging request carry more weight. Incomplete orders can be a big problem.

Material, frame, PD, segment heights, and AR all need to be clear. Rush jobs are for busy time, and that’s the worst time to try to track down a busy dispenser to get a measurement, or to figure out why the invoice says 1.67, when polycarbonate lenses are in the tray. (see below) Do show A co-worker stood out. He brought trays to me and would pause and say, “Here are your frame and lenses. How soon can I have them made?” He approached me this way every single time, whether the office was busy or slow. Don’t dismiss this formality. It gave us a helpful moment to look at the materials (frame and lenses). Cut out problems were avoided, remakes were reduced, thick enough lenses were ordered for grooving, and wrap optics were improved. (Thanks, Erik) Don’t cry wolf Finding out that hour job you asked for wasn’t really needed right away can be discouraging to your staff. You want them to take your rush jobs seriously, so pick and choose them and you can be firm the next time you need something pronto.

Do assist If you are able to pitch in without disrupting the flow, the next time you have some down time, see if you can spot some incoming lenses, and verify a few finished jobs. Sometimes a little help with even a few jobs makes all the difference in the world to a maxed-out lab. The key here is to not disrupt the flow out back or the coverage out front.

Don’t jump the gun It’s true that good customer service means exceeding customer expectations. But is it really necessary for each job to be an hour job, or might it be wiser to evaluate each situation?

There’s an art to exceeding customer expectations on one hand, and under-promising on the other. It usually is possible to keep

all parties happy. The key is not responding automatically.

Glasses needed by the end of the week? Maybe you can promise them for tomorrow. If they want them tomorrow, consider promising for later on today. Patient needs them today? Wow them with one-hour service.

Don’t assume Trays seem to be piling up in the lab? Maybe they’re standing still because other trays are moving out. Your lab staff is aware, too. Edgers only grind one lens at a time. In order to edge any job, other jobs have to wait. It only makes sense. The lab is up to their elbows in work, and won’t be able to get your rush job done quickly? Maybe they are prioritizing, and are letting nonrush jobs pile up. When we are all busy, it can be hard to read our co-workers, so it’s important to not assume.

Do appreciate Lab staffers are there because they like what they do. They crave challenges and thrive on multi-tasking. They want to get the highest priority jobs finished and approved the soonest. Your lab staff likes challenges. The best challenges usually are those giving the best optics with the least compromise.

Show interest Be considerate. Instead of saying “I only want to know if a standard lens will work,” listen to your lab staff ’s suggestion of the proper way to do things. Otherwise, you are sending the message that you just want to get through things. The lab wants to help when a lens is problematic and falls out of the frame.

This is why they suggest the right material choice, such as aspheric high index for high plus. Lab staffers have a hands-on appreciation for lens form, and thickness. You might not be able to take their suggestion every time, but it’s important to hear reasonable advice. Polycarbonate lenses might be best for a particular grooved job to avoid chips, flat high index lenses might be incompatible with a curved frame, and a thicker frame might cover lens thickness and conceal the effects of prism in the Rx. You can take lab tips like these and turn them into dispensing tips in the future, so don’t dismiss them. ■

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Through the Lens Carrie Wilson, BS, LDO, ABOAC, NCLEC

Anti-Reflective Coating: The Perfect Finishing Touch Coatings of Today Gone are the days of single layer AR coatings that craze, scratch or smudge easily. Today’s premium AR coatings have extra hard coatings that increase its scratch resistance, as well as oleophobic, hydrophobic and anti-static layers that help repel oil, water, and dust. Not only do these layers decrease the amount of debris and dirt that stick to the lens, but they also make the lenses easier to clean and thereby reduce surface scratches from excessive cleaning.

• Oleophobic layers are especially important with the multilayer coatings because the more effective the coating, the more likely it is to show smudges.

ANTI-REFLECTIVE (AR) COATING is commonly seen on an ECP’s glasses, but not seen as often on the lenses of their patients. According to the Vision Council, only 28.5% of eyewear dispensed in the United States in 2005 had AR coating on the lenses. This is far behind the foreign market rate of 50% to 99% penetration. Why is this? Common reasons may be the ECP is wary of the new coats due to past failure rates of AR coatings, an incomplete understanding of the way AR works and the benefits it provides, or they are unsure how to present the product to the patient in an effective way.

What is Anti-Reflective Coating?

Anti-Reflective (AR) coating is a series of layers that is adhered to the back and front surface of a lens, or just the back if the lens is polarized, to help reduce the amount of reflections on the lens. Consisting of metal oxides, each layer is a thin film that is designed to block a specific wavelength of light. The more layers of film, the more wavelengths that are blocked. Working by the destructive interference, AR causes the light that reflects from the inner and outer surfaces of each film layer to become equal, thereby canceling each other out.

22 | EYECAREPROFESSIONAL | SEPTEMBER 2009

• Hydrophobic layers are thin layers of silicone that are placed on top of the AR. It provides a smooth surface that decreases the wetting angle of the lens. The result is that liquids form small beads that can be easily removed from the lens.

• When oleophobic and hydrophobic layers are used together, they create a seal that acts as a secondary scratch coat.

• Anti-static or Electro Magnetic Interference (EMI) layers are place on the lens to prevent static build up. By reducing static on the lens, airborne particles are a lot less likely to be attracted to the lens and adhere to it.

• Premium AR coatings are actually bonded to the lens surface, becoming one with the lens. This decreases the likelihood of crazing that was a problem with earlier AR coats.

Reaping the Benefits Now, how does all this scientific data actually help the patient?

Well, AR allows 8% more light to enter the eye. The result is clearer, sharper vision and reduced eyestrain, which would benefit everyone, however in some situations, the benefits are more noticeable.

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• Occupational – Fluorescent lighting, computers, cash registers, etc, all cause an increase of reflections in the workplace. This increase in reflections causes eyestrain, headaches, fatigue and a decrease in work productivity.

• Night driving – External reflections are a major problem when it comes to driving safely at night. The reflections from oncoming headlights, streetlamps, and the road can cause distractions and discomfort to the driver. Internal reflections can cause ghost images and result in a decrease in reaction time.

• Sunwear – Backside AR can eliminate a couple of problems related to sunwear. First is the annoying image of the eye that is reflected in the center of the lens and can be very distracting. The second is the glare hazard that is caused by the mirror effect of a dark lens. With sun lenses, light from behind the wearer can be reflected directly into the eye from the back of the lens surface causing discomfort. Be sure not to place AR on the front surface of a polarized lens because it affects the polarization process and can reduce the darkness of the polarized lens by as much as 8%.

• Cosmetic – Shakespeare once said, “The eyes are the window to the soul.” If reflections are inhibiting eye contact and eye visibility, much can be lost. AR coating enhances not only the appearance of the patient but can increase the effectiveness of communication by enabling better eye contact.

Premium AR coatings on the Market Getting premium AR coatings are easier than ever. Several manufacturers have developed AR coatings that work best with their lens substrates. Some of the most common manufacturers and their AR coatings are: Hoya and HiVision has developed a process that matches the index of the coating to the individual lens substrate and sandwiches it between a super hard scratch resistant coating and a hydrophobic top layer.

Essilor has a family of AR coatings under the Crizal® name. The newest member of that family is Crizal Avancé™ with Scotch Guard™. Crizal coatings go through an eight step process that combines super scratch resistance with hydrophobic, oleophobic and antistatic topcoats to the AR coat.

Seiko has a patented AR coating called SuperClean AR. It has a super hyprophobic top coat, a high index non-tintable hard coat, and a high index shock absorbent primer. The result is an AR that repels dust, dirt and grime and is easier than ever to clean.

It is found on the Seiko 1.74 and 1.67 hi index lenses. In their Pentax family of lenses, Seiko has developed the Surpass® ECP AR coating. Surpass combines hydrophobic and oleophobic layers to create a super top coat that prevent AR deterioration from temperature fluctuations, UV, and humidity.

Continued on page 24

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Recommending AR to the Patient Although some surveys show that 60% of patients would purchase AR coated lenses, only about 25% of them do. It is up to the ECP to bridge this gap. The easiest way to prove the benefit of AR coating is to demonstrate it. With this in mind, everyone in the dispensary should be wearing the product. It is hard to tell a patient that the product will benefit them if the ECP doesn’t believe in the product enough to wear it.

Also, seeing is believing when it comes to a product, so be sure that there are multiple types of AR displays available in the practice. These displays should show a specific benefit of the product. Very effective types of displays include:

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Carl Zeiss has a wide range of AR coatings available. In the SOLA line, the AR is Teflon® with clear coat. In the Zeiss line, AR coat is available with either the Carat® family of AR coats or the ET family of AR coats. The newest member of the Carat family, Carat Advantage® has a new super hydrophobic coating.

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24 | EYECAREPROFESSIONAL |SEPTEMBER 2009

• The doughnut. The doughnut is a plano lens with AR coating applied just to the center. When placed against a dark background, it is very easy to see the difference in the amount of light reflected between the coated and uncoated portions.

• Glasses with a coated lens and a non coated lens. This display is very effective for the fashion conscious consumer because it really highlights the cosmetic benefits to the patient, so be sure to place it in a stylish frame. With this display, the patient can see how the coating will actually look when being worn.

• An oleophobic/hydrophobic lens and a permanent marker. Patients are familiar with permanent markers so they are impressed when the ink of the marker beads up on the coating and is easily wiped off without leaving a mark.

A word of caution, although everyone can benefit from AR coated lenses, AR coating does not work well under certain environmental conditions. If a patient works in an extremely dusty environment, it would probably benefit them to buy a second pair of occupational glasses without AR coating applied to the lenses. Also, be sure to explain proper care and cleaning – as detailed by the manufacturer – so that the patient can get the longest possible life out of the lenses.

AR coatings are the icing on the cake when it comes to lenses.

They enable the wearer to see things clearer, reduce eyestrain, increase productivity as well as participate in activities more safely. With all these benefits, it is important to recommend AR to every patient. By believing in the product and showing the benefit, the ECP can provide their patient with the care they deserve. ■

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Bella 4th grader Big sister Checkers champion

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The first move is often the most important one.

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Managing Optician Lindsey Getz

ECPs on the Web Don’t get left behind—more ECPs than ever before are plugging into the worldwide web ITH NEARLY 75 percent of our nation’s population accessing the worldwide web, it’s become more important than ever for successful eyecare practices to have an Internet presence. While it may seem intimidating, you don’t have to be tech savvy to get up and running. We spoke with several different ECPs who have launched or are in the process of launching a site, about why they did it and what’s involved.

W

“In today’s world people are using computer search engines more and more as their first choice in locating doctors,” says Therese C. Deschenes, OD, Deschenes Eye Associates in Trooper, Pa., who at press time was in the midst of developing an interactive website. “Websites are available for people to browse at their own leisure. You can convey so much more information through a website than in a printed ad or even a phone call.”

Joni Schrup, owner, Discerning Eye in Iowa City, Iowa agrees. She says it was her kids that pushed her to get on the web. In fact, her son Sam was responsible for creating her site, before her eyecare practice even launched in December 2005. “Talking to my kids, I realized their generation doesn’t even know how to operate a phone book,” she says. “We’re based in a college town and I think it’s made me a little more aware of the fact that younger crowds no longer use the

28 | EYECAREPROFESSIONAL | SEPTEMBER 2009

Yellow Pages. So it was always important for me to have a good online presence, from the very beginning.”

Visibility is definitely one key benefit of being online, but a website is also a way for patients to get a feel for your practice before they even set foot through the door. It was important for Rachel Cohn, OD, optometrist and owner of Wink Eyecare Boutique in Potomac, Md., to have a catchy look to her site.“My boutique has a hip feel to it, and you get a sense of that from just visiting my website,” she says. “It was important to me that my site was completely reflective of my brand so everything from the logo to the colors we used and the photos on the site conveys that same feeling.”

Another, perhaps unconsidered, benefit of a website is making sales. While many ECPs think in terms of recruiting local patients through the Internet, Schrup says her website actually helped her make a sale with an out-of-state customer. “We just recently had a man from California call us because he was looking for a specific frame line and ended up finding it on our website,” she says. “He bought a pair of frames that we’re going to be mailing to him.”

And a website isn’t the only way to get some web presence. For instance, Schrup created a Facebook page for her practice. Staff photos and photos of frame reps are posted on the page

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regularly. It’s also a space for her to let existing and prospective patients know about events and happenings taking place at her practice. And of course, it’s yet another way that patients can get in touch with her.

additional information can also log on to Bazan’s blog, which he updates regularly with educational content. “I look at the blog as more of an educational tool and put up posts that help our patients find useful medical information,” he says.

Justin Bazan, OD, owner, Park Slope Eye in Brooklyn, N.Y., also makes use of various social media and networking tools, which are linked on his website. In addition to a Facebook page, he also uses Twitter. “Social media and networking gives us the ability to create more of a fan base,” he says.“And fans are exactly the type of patients we want to have here. We want people to feel an extreme loyalty to our practice and that’s something that can be generated through the interactions we have on these forms of online media.”

Getting Started Your website’s content is definitely the first thing you should consider when launching a website. The most important items to include are where you’re located, what your hours are, and how to get in touch with you. Often times web visitors are only looking to pop on to your page to get some quick info, so it’s helpful to have these three pieces of information on your homepage. Some practices are even doing their scheduling

“In today’s world people are using computer search engines more and more as their first choice in locating doctors,” says Therese C. Deschenes, OD, Deschenes Eye Associates in Trooper, Pa. Through his Facebook page, Bazan posts interesting content in the hopes of generating discussion. It’s also an outlet for him to answer patients’ quick questions. He started the page in November and now has close to 500 “fans.” Patients looking for

through their website. This allows patients to go online and make an appointment 24/7, though it obviously requires upkeep from your end as well, making sure you are staying on top of appointments booked this way.

Continued on page 30

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Besides the obvious, there are many other features and pieces information to consider adding to your site. For Schrup, highlighting some of the frame lines she carries was very important.

Besides the fact that it helped her make a sale just by having the list online, it also helps her recruit new patients who are impressed by her selection.

Some information on the office staff is also vital so that the patient can feel more familiar with the practice. “I think it is very important for patients to be able to meet the doctor and view credentials and experience,” notes Deschenes. “Patient testimonials are also important, as is listing services offered and [the practice’s] specialized areas.”

When it comes to design, how barebones or fancy you want your website is entirely up to you. Linda Fain Hatton, OD and president of Optix EyeCare and Gallery in Dallas, even includes EyeCyclopedia™ on her website, giving patients an opportunity to look up eye conditions and definitions. She also has downloadable videos available. Bazan has a highly interactive site that has a bold color scheme and makes use of Flash with unique graphics and other features, allowing it to have a lot of impact on visitors. No matter what you decide to do, keep in mind that launching a site is a chance for you to be creative. Just don’t forget the type of message and the overall feel you want to convey to your visitors as you come up with ideas.

Once you determine what features and information you’re going to include, you’ll have to decide if you plan to create the site yourself using an Internet domain registrar. There are a lot out there, Go Daddy being one of the most well-known, most likely due to their flashy Super Bowl ads. Others choose to have a web developer do the work. This is a more expensive route, but can save a lot of time and ensures a professional look.

Deschenes says she did her homework before settling on the developer she planned to use for her site. “I researched many web developers and viewed samples of their sites,” she says.

“I also did price comparisons for the services that are offered.”

And Deschenes feels the cost is certainly worth it. “The cost of having a website for a busy practice should be an expected operating cost in this day and age,” she says. “Before it used to be the telephone book was the first resource for finding businesses or doctors. Simply reallocating those expenses to your website is very easily done. Web developers are very willing to help those whom are not very computer savvy. And it’s an investment that will definitely give a good return on your dollar.”

Creating a Facebook page or blog is often easier than launching a website since it walks you through the steps and is perhaps a good place to start out for the web newbies. The bottom line is that no matter how you go about it, creating an online presence is an excellent way to market your practice to new patients and make important connections with your existing patient base. ■

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Second Glance Elmer Friedman, OD

Credit: Associated Press

Giving Hope to the Blind It’s like a lollypop. With an inch square grid containing 625 small metal receiving sensors. A wire leads from it to a camera mounted on a pair of sunglasses and then connects to a hand held instrument much like a BlackBerry.

THE CAMERA SENDS its image to the tongue device which emits a low voltage pulse to the tongue. Concentration and training allows the subject to visualize a picture. The subject can identify the shapes of images before him, even though the condition of blindness exists. The tongue is more sensitive than other skin areas.

The nerve fibers are close to the surface, there are more of them and there are no outer layers of dead cells that may interfere. It requires less stimulation. Five to fifteen volts is all that is needed in comparison to 40 to 500 volts for areas like the fingertips, abdomen or back. Electrolytes contained in the saliva helps to maintain the current between the electrode and tongue tissue.

The area of the cerebral cortex that receives the data from the tongue is larger than areas serving other body parts, making the tongue a logical choice for this process.

Amy Nau is an optometrist at the Univ. of Pittsburgh and is investigating the effectiveness of the instrument. She said during a Washington Post interview, “It’s kind of like Braille that you use with your fingers. Instead of symbols, it’s a picture and instead of fingertips, it’s your tongue.” The magic lollypop is called the BrainPort Vision Device. It is made by Wicab, Inc., a biomedical engineering company in Middleton, Wisconsin. It utilizes sensory substitution. This is a function that becomes operative when one sense is damaged. The part of the brain that was meant to control that skill can be taught to perform anoth-

Injured Marine Corps Cpl. Mike Jernigan uses the BrainPort

er function in its place. The visual cortex is asked to learn tactile recognition. The supposition is that we do not see with our eyes. The optical image rests on the retina where a neuro chemical process takes place and it becomes a nerve impulse along the optic nerve fibers. The brain receives the impulses and projects a recreation of the image. And that is an uncomplicated version of how we see.

There are numerous pathways that carry sensory information to the brain. The eyes, ears and skin are all set up in a similar manner to perform their special activities. All this information is carried to the brain by nerve fibers in the form of impulse patterns. Each ends up in different brain areas for interpretation. To substitute one pathway for another – as has been suggested – an accurate encoding of the nerve signals for the sensory activity is required and thence transported to the Continued on page 34

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parietal area of the brain. The brain has the facility to be trained to read inputs for interpretation and to react accordingly. The encoding of the electrical pattern attempts to mimic the input from the non functioning sense.

sink gets clogged up and you have pieces lying on the floor, my ‘lollipop’ helps me to find the pieces.” His camera equipped

Usually, the parietal lobe receives touch information, the temporal lobe receives auditory information, the occipital lobe receives vision information and the cerebellum receives balance information. Experts agree that it is a mystery as to how this all takes place but the brain accomplishes this miracle if the correct information is given to it. Further study is being made to help the hearing impaired, the balance impaired and those who have lost their sense of touch in certain areas of the skin due to nerve damage. A seemingly impossible endeavor is being considered to use electrotactile stimulation for sensory augmentation or substitution to sense colors.

Marine Cpl. Mike Jernigan was blinded by a roadside bomb in Iraq. The doctors gave him no hope of retrieving any part of his lost sight. After five years of sweat and tears, he and his support group of people have brought him beyond the “white cane” scenario. He is one of an experimental group of 100 blind people who are testing the instrument.

Jernigan reports, “It is designed for stationary tasks. If the camera were to transmit images of a moving scene, there would be too much information to process at once. However, when your

sunglasses were made by Oakley. Jernigan adds, “For five years I have stared at a blank, black screen. Now, people are thinking outside the box and by doing so, this allows someone like me to have hope of the possibility that I might see again.”

Bob Beckman is the president and CEO of Wicab. He says, “When you were a child, did anyone ever draw a picture on your back with a finger tip?” He continues, “Receiving information by the BrainPort is similar to the perceptions caused by the finger on the back drawing experience.”

Continued on page 36

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Dr. Nau suggests that the image sensations produced are very rudimentary. Stereopsis is unattainable and images are perceived as blocks and shapes in black and white. Beckman feels that his mission is to provide information to the blind, not to cure blindness. “I feel that we are in the infancy of this technology.” he said. Mr. Beckman added that he feels the instrument may be commercial by the end of 2009. It is estimated that it will cost about $10,000. The Univ. of Wisconsin has patented the concept and gave Wicab the exclusive rights of licensure.

Veteran Navy Diver, Michael Zinszer used the BrainPort system to sense compass direction and depth while in a swimming pool. He said it felt like having soda pop bubbles on his tongue.

Zinszer added, “You are feeling the outline of the image. While I was in the pool they directed me to a very small object and I was able to locate it very easily.”

Erik Weihenmayer lost his vision at the age of thirteen due to a congenital eye disease. He is a 40 year old mountain climber, author and inspirational speaker. He states that he can see size, shape, location and motion of objects in black and white. Black objects on a white background afford better contrast compared with images of low contrast such as people dressed in pastels set against foliage in a park. He adds that the picture, even with

36 | EYECAREPROFESSIONAL | SEPTEMBER 2009

high contrast benefits, is much cruder than that of a sighted person’s normal vision. To Mr. Weihenmayer’s delight, he regales in telling how he caught his daughter cheating at cards.

In another celebrated case, a woman who has been blind since birth and never developed any idea of what a rubber ball should look like was tested with the BrainPort instrument. The investigating director rolled a ball in her direction and she put out her hand to stop it.

Paul Bach-y-Rita, a neuroscientist at the Univ. of Wisconsin, was the founder of Wicab and reported his discoveries more than thirty years ago. Other researchers who have become deeply involved with developing the progress of the BrainPort device are: Dr. F. Owen Black at the Legacy Clinical research and Technology Center in Portland, Oregon and Dr. Maurice Ptito of the Univ. of Montreal School of Optometry and Dr. Eliana Sampaio of the National Conservatory of Arts and Trades in Paris. It is expected that with the advent of electronic miniaturization and more powerful computer properties, the technology will become less cumbersome and more practical with improved results. ■ “Anything one man can imagine, other men can make real.”

JULES VERNE

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ABO Prep Dee Carew, ABOM

OPTICAL PRISM IS DEFINED as a wedge-shaped transparent object that deviates light. The light deviates, or bends, toward the base, and when you are looking through the prism, the image moves toward the apex.

Unwanted prism can cause discomfort including visual distortion, headaches, nausea and blur. It is often caused by lab errors in surfacing, laying out or edging or optician errors in measuring the seg height or PD. Lenses Contain Prisms Ophthalmic lenses inherently contain prisms. Minus lenses are two prisms apex to apex and plus lenses are two prisms base to base. Depending on where light passes through the lens, it goes straight or bends. The optical center is where there is no prism and light goes straight through. When light passes through at any point other than the optical center, it bends and affects the vision. This is called prismatic effect.

The Major Reference Point (MRP) of the lens is the place where the prescription is its clearest and most accurate. The Pupillary Distance (PD) is the distance from center pupil of one eye to center pupil of the other eye. The Optical Center (OC) is the point on the lens where light passes straight through and where there is no prism. Ideally, the PD and the MRP are at the same place. If there is no prescribed prism, we want the PD, MRP and OC to be at the same place.

If the prescription calls for prism, the MRP and PD are at the place corresponding to the amount of prism required in each eye. If no prism is prescribed, but the MRP and OC are not positioned at the same place in the lens, prism is induced. This happens because when the wearer looks anywhere other than the OC, he is looking through some point in the prisms that make up the lens. When the wearer’s MRP is not positioned at the OC, he is looking through the lens prisms. Because he is looking through the lens prisms, his vision is altered. The farther away from the OC that the light passes through the lens, the more prism is induced.

The way to calculate how much prism is induced is by using Prentice’s Rule. (This is an approximation and becomes less accurate in lower lens powers.)

= D x d 10

is the symbol for prism diopter D is the symbol for power of the lens d is the symbol for decentration in millimeters

The 10 is used to change the distance values from centimeters to millimeters. Since opticians are used to using millimeters, we change everything into millimeters to better understand the math. In the case of this formula, the end result is in prism diopters.

If the power of the lens is -6.50 and the eye is looking through it 2mm away from the optical center, the amount of prism is figured by Prentice’s Rule: = D x d 10 D = 6.50 x 2 mm 10 D = 13 10 D = 1.3 or 1.3

Base Direction As for the direction the light bends, called base direction, we consider whether the lens is minus or plus. You must consider where the eye is looking, not where the light is striking, to determine base direction.

Our eyes are sensitive to unwanted or unfamiliar prism. The more prism there is, the more discomfort it can cause.

Excessive Base Down Prism causes the sensation of standing in a bowl. The wearer feels like he is walking uphill and vertical objects appear taller than they really are.

Excessive Base Up Prism causes the sensation of standing on a hill. The wearer feel like he is walking downhill and vertical objects appear shorter than they really are. Excessive Base In or Out Prism causes the wearer to see horizontal objects as slanted.

Continued on page 40

38 | EYECAREPROFESSIONAL | SEPTEMBER 2009

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Canceling prism

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When each lens contains the same amount of horizontal prism and in opposite directions, one base in and one base out, the prism in both eyes cancels each other out and there is no effective prism in either eye.

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When each lens contains horizontal prism with the bases in the same direction, the prism is compounded, wherein the prism in both eyes is added together for a total amount of OU prism.

When each lens contains vertical prism with the bases in opposite directions, the prism is compounded, wherein the prism in both eyes is added together for a total amount of OU prism.

Split prism To even out the lens thickness that prism can cause, the amount of prism can be split in half with each half assigned to a lens.

Vertical prism in the prescribed lens will have the base direction prescribed, while the other lens will have the opposite base direction.

For example, the Rx calls for 8D of prism base down OD. To split the prism evenly, the OD lens will have 4D of prism base down and the OS lens will have 4D of prism base up.

Base direction for horizontal prism will be the same in each lens.

For example, the Rx calls for 8D of prism base out OD. To split the prism evenly, the OD lens will have 4D of prism base out and the OS lens will have 4D of prism base out.

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Yolked prism is prism in the left and right lens that have the same base direction and do not cause the eyes to converge or diverge, either horizontally or vertically, relative to one another. Yolked prism is also used in progressive lenses to make the upper portion of the lens lighter and thinner. This is called prism thinning.

Image Jump When a bifocal wearer’s gaze moves from the upper portion of the lens to the lower portion of the segment, the image suddenly appears closer and magnified. This is called image jump. This happens because prism is induced when looking away from the Continued on page 42

40 | EYECAREPROFESSIONAL |SEPTEMBER 2009

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optical center of the upper portion to the OC of the lower portion. The amount of image jump depends on the placement of the optical center in the segment.

or slab-off. This method is limited to compensating for a maximum vertical imbalance of six diopters.

Verifying prism

When the gaze moves from the upper portion of a plus lens to the top of the segment, base up prism is created and the image moves down slightly. The prism is base up because the base of the prism in the upper part of the lens is at the distance optical center. As the gaze continues to move down into the segment, the base direction of the prism in the segment determines whether there is image jump and how much.

When the gaze moves from the upper portion of a minus lens to the top of the segment, base down prism is created and the image moves up slightly. The prism is base down because the base of the prism in the upper part of the lens is at the outside of the lens. As the gaze continues to move down into the segment, the base direction of the prism in the segment determines whether there is image jump and how much.

Anisometropia A difference in prescription or MRP between the lenses is called anisometropia. When the wearer lowers his gaze below the distance optical center anisometropia causes Vertical Imbalance, which is prismatic effect usually felt when the difference between lenses is greater than 1.5 prism diopters. The person affected by vertical imbalance is the bifocal wearer with good vision in both eyes. If one eye is defective or blind, the difference between the lenses will not matter.

Slab-Off When anisometropia causes vertical imbalance in a set of bifocal lenses, we can have prism ground into one lens’ segment to cancel out the prism created by the different prescriptions. Base up prism equaling the amount of prism caused by the Rx is ground into the reading segment of the lens with the more minus in the distance portion. This is called bi-centric grinding

42 | EYECAREPROFESSIONAL |SEPTEMBER 2009

To verify prism when the prescription is known, dial in the prescription on the lensometer and place the mires at the prescribed place for the prism and spot the lens. After doing this on both lenses, measure the distance between the dots and the result should match the PD. When the prescription is unknown, we can estimate the amount of prism by placing the higher powered lens on the lensometer stage where the PD would most likely be and noting where the mires are positioned. Then we carefully shift the glasses to place the other lens on the stage. If the mires are positioned somewhere other than in the center, make a note of the position. The positions of the mires will indicate that there is prism and approximately how much between the two lenses.

Another method used to check for prism when the prescription is unknown is to place the stronger lens on the lensometer stage and center the mires. Then evenly shift to the other lens and note where the mires are positioned. This will tell approximately how much prism is present between the lenses, but not which lens it’s in or if the prism is split between the lenses.

To verify or check for prism in a progressive lens, we use the progressive mask that covers the lens when a job comes from the lab. Under the fitting cross is a dot and we put this dot at the center of the eyepiece on the lensometer. We check both lenses at this dot and if there is no prism, the mires for both lenses will be at the same place on the reticle. If there is prism, the mires of each lens will be at different places on the reticle.

Understanding prism may be a little daunting at first, but if you take the information one concept at a time, it will fall into place and you will better understand why prism affects vision— whether we want it to or not. ■

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Corning

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WEB SITE

29

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23, 45

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9

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47

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36

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19, 31, 35, 41

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40

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39

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13

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11

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email: info@opticom-inc.com www.opticom-inc.com

48 | EYECAREPROFESSIONAL | SEPTEMBER 2009

Our “Free” Lens Series offers one-of-a-kind bifocal designs that fill a void in the optical industry. With our unique, patented “Round Seg” technology, your patients will experience the best in bifocal lenses.

Get in the “O” Zone Today

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Drivewear lenses uniquely combine two of the most advanced technologies found in the industry today: Transitions™ Photochromic Technology and NuPolar® polarization. Drivewear is the first polarized photochromic lens to darken behind the windshield of a car.

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INDUSTRY QUICK ACCESS

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National Lens America’s Leading Discount Contact Lens Distributor

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Call 877.274.9300 for info and catalog.

CE

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Phone 1-866-923-5600 Fax 1-866-923-5601 www.national-lens.com National Lens, a leading independent distributor of Contact Lenses is pleased to announce their Exclusive Distribution rights of Impression Colored Contact Lenses in the U.S.A.

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According to the director of sales David Roberts, these Opaque Lenses are extremely comfortable are available in nine colors and offer a major price advantage over the leading competitor’s lenses.

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Last Look Jim Magay, RDO

“Are They Trifocals?” –

“No, Trufocals!”

O YOU may have seen the recent article in the NYT Science section about a new product called Trufocals. It is a fluid filled Rx lens that adjusts power with a bridge-mounted slider that adjusts the near power from none to +2.75 and back again.

S

The design consists of three parts; a back glass, a fluid-filled inner membrane that is essentially a piece of plastic-wrap-like material stretched across a ring whose surface curvature can be altered mechanically, and an outer prescription lens attached with magnets to the eyeglass frame. To change the focus, the user moves the slider on the bridge.

It is the brainchild of inventor Steven Kurtin – and Harry Potter would love them – they are perfectly round. (If you wish to have a liquid filled adjustable lens it must be round – no ifs, ands, or buts about it!) Steven is a long time inventor with a Cal-Tech degree in applied physics. Lest you think this is a dilettantish pursuit, Kurtin and his wife and many associates have invested millions in the research. The basic idea of a fluid lens whose focus can be changed mechanically goes back to a patent awarded in 1866, so obviously it is an insanely complex mechanical problem or we would have seen many iterations of the idea by now.

Another approach was tried by Luis W. Alvarez, (who in 1968 won the Nobel in physics), who posited a two-part lens that changed focus by sliding two lens components of opposing “saddle-back” shapes across each other.

50 | EYECAREPROFESSIONAL | SEPTEMBER 2009

Several international efforts are under way to adapt both fluid lenses and the Alvarez approach to the 1.3 billion people at the bottom of the economic pyramid that the WHO estimates as having no access to eyeglasses.

Both the Center for Vision in the Developing World in Oxford, England, and U-Specs in Amsterdam (using the Alvarez principle) are working on glasses that can be distributed at a fraction of the price that glasses cost in the developed world.

Then there is Professor Joshua Silver who has invented a very basic silicone filled user adjustable lens and frame combination.

The user injects more silicone fluid into the interstices in the lenses to sharpen their focus, then breaks off, or locks the syringe, once the wearer is satisfied with the vision obtained (No – the syringes can’t be used for anything else).

On top of this our friends at PixelOptics are developing an electro active lens that was demonstrated last spring at Vision Expo and may come out next year. This would probably be a logical competitor to Kurtin’s glasses when it comes on the market.

But first to market honors must go to Trufocal at a whopping $895.00 retail. Multicolored temples are available and the bridge sizes vary with PD. Beauty is in the eye of the beholder, a group of Trufocal wearers would not make the fashion gods quake, but they might incite a bit of jealousy among Harry Potter fans. ■

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Largest selection of finished Transitions!

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See us at Vision Expo West in Booth 9033 www.seikoeyewear.com

*Available in October ‘09

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PRODUCED AND DISTRIBUTED BY LUXOTTICA GROUP - MOD. RX 5154

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